Wang Jingpu, Hu Jingfeng, Zhu Dengyan, Wang Kankan, Gao Chunzhi, Shan Tingting, Yang Yang
Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
Transl Cancer Res. 2020 Mar;9(3):1518-1527. doi: 10.21037/tcr.2020.01.45.
Minimally invasive esophagectomy (MIE) is increasingly accepted in many countries. McKeown esophagectomy and Ivor Lewis esophagectomy are two protocols commonly used for MIE, but which one provides more benefit to the patients remains matter of controversy.
All records in PubMed, Embase, Medline, The Cochrane Library, Wanfang Database, China National Knowledge Infrastructure (CNKI) and Chinese VIP Information till May 2019 were systematically retrieved to compare the cohort studies of McKeown esophagectomy and Ivor Lewis esophagectomy. A meta-analysis of the extracted data was performed using the Review Manager 5.3 and Stata 15 software.
The meta-analysis included 23 cohort studies in which a total of 4,933 patients were enrolled. The results revealed that minimally invasive McKeown esophagectomy (MIME) was superior to minimally invasive Ivor Lewis esophagectomy (MILE) in hospital cost, but inferior to it in operating time, length of hospital stay, in-hospital mortality, 30-day mortality, 90-day mortality, anastomotic leakage, anastomotic leakage requiring surgery, anastomotic stenosis, recurrent laryngeal nerve (RLN) injury, chylothorax, pulmonary complications and total complications. There were no statistical differences between MIME and MILE in blood loss, detected number of lymph nodes, blood transfusion rate, R0 resection rate, re-operation rate, drainage duration, length of the stay in intensive care unit (ICU), 1-year mortality, lung infection, cardiac arrhythmia and delayed gastric emptying.
Except for the cost, MILE is superior to MIME in several aspects, and may represent a better choice for MIE. The results of the present study should be interpreted with caution since the meta-analysis is based on nonrandom cohort studies which may have a selection bias.
微创食管切除术（MIE）在许多国家越来越被接受。麦克尤恩食管切除术和艾弗·刘易斯食管切除术是常用于MIE的两种术式，但哪种术式对患者更有益仍存在争议。
系统检索截至2019年5月在PubMed、Embase、Medline、Cochrane图书馆、万方数据库、中国知网（CNKI）和中文维普资讯中的所有记录，以比较麦克尤恩食管切除术和艾弗·刘易斯食管切除术的队列研究。使用Review Manager 5.3和Stata 15软件对提取的数据进行荟萃分析。
荟萃分析纳入了23项队列研究，共纳入4933例患者。结果显示，微创麦克尤恩食管切除术（MIME）在住院费用方面优于微创艾弗·刘易斯食管切除术（MILE），但在手术时间、住院时间、院内死亡率、30天死亡率、90天死亡率、吻合口漏、需要手术的吻合口漏、吻合口狭窄、喉返神经（RLN）损伤、乳糜胸、肺部并发症和总并发症方面不如MILE。MIME和MILE在失血量、淋巴结检出数、输血率、R0切除率、再次手术率、引流持续时间、重症监护病房（ICU）住院时间、1年死亡率、肺部感染、心律失常和胃排空延迟方面无统计学差异。
除费用外，MILE在几个方面优于MIME，可能是MIE的更好选择。由于荟萃分析基于可能存在选择偏倚的非随机队列研究，本研究结果应谨慎解读。
